目的

分析比较乳腺癌患者乳腔镜下腋窝淋巴结清扫术(MALND)和常规腋窝淋巴结清扫术(CALND)的术后恢复及并发症发生率。

方法

本研究为前瞻性研究。 依据患者纳入和排除标准,将2015 年6 月至2016 年6 月在中国医科大学附属盛京医院第二乳腺外科诊治的60 例乳腔镜下腋窝淋巴结清扫术的乳腺癌患者(MALND 组)作为研究对象,根据患者年龄及乳腺癌TNM 分期1 ∶1 配对选择同期60 例常规腋窝淋巴结清扫术后的乳腺癌患者为对照组(CALND 组),采用配对资料t 检验分析比较2 组患者术后日引流量、拔管时间,采用配对资料χ² 检验分析比较2 组患者术后皮瓣坏死、上肢水肿、感觉异常的发生率。

结果

MALND 组术后腋窝平均日引流量为(17.7±7.2) ml,明显少于CALND 组的(21.4±6.8) ml(t= 2.959,P=0.004);MALND 组术后腋窝平均拔管时间为(7.5±2.3) d,明显小于CALND 组的(8.8±4.1) d(t= 2.057,P=0.044);MALND 组皮瓣坏死发生率为0(0/60),明显低于CALND 组的10.0%(6/60)(P=0.031);MALND 组上肢水肿发生率为3.3%(2/60),明显低于CALND 组的13.3% (8/60)(P=0.031);MALND 组感觉异常发生率为23.3% (14/60),明显低于CALND 组的41.7%(25/60)(P=0.001)。

结论

乳腔镜下腋窝淋巴结清扫术手术损伤小,术后恢复快,明显减少了皮瓣坏死、上肢水肿、感觉异常等并发症的发生率,提高了患者术后生存质量,值得临床推广。

Objective

To analyze the postoperative recovery and complications of breast cancer patients after mastoscopic lymph node dissection (MALND) or conventional axillary lymph node dissection(CALND).

Methods

This was a prospective study. According to the inclusion and exclusion criteria,60 breast cancer patients who received MALND in Shengjing Hospital Affiliated to China Medical University from June 2015 to June 2016 served as research group (MALND group). The other 60 breast cancer patients who received CALND served as control group (CALND group) based on the principle of 1 ∶1 paired selection.Paired t test was used to compare the postoperative daily drainage volume and drainage duration between two groups. Paired χ² test was used to compare the incidence of skin flap necrosis, upper extremity edema and abnormal sensation between two groups.

Results

The postoperative daily drainage volume was (17.7±7.2) ml in MALND group, significantly lower than (21.4±6.8)ml in CALND group(t= 2.959, P=0.004). The drainage duration was (7.5±2.3) d in MALND group, significantly shorter than (8.8±4.1) d in CALND group (t = 2.057, P = 0.044). The incidence of skin flap necrosis was 0(0/60) in MALND group,significantly less than 10.0% (6/60) in CALND group (P=0.031). The incidence of upper extremity edema was 3.3%(2/60) in MALND group, significantly lower than 13.3%(8/60) in CALND group(P=0.031).The incidence of abnormal sensation was 23.3%(14/60) in MALND group, significantly lower than 41.7%(25/60) in CALND group(P=0.001).

Conclusion

Mastoscopic axillary lymph node dissection can reduce postoperative complications such as skin flap necrosis, upper extremity edema and abnormal sensation and improve the patients' quality of life, with small surgical injury and fast postoperative recovery, so it is worthy of clinical application.